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American Journal of Clinical Nutrition, Vol. 86, No. 5, 1405-1413, November 2007
© 2007 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Effect of a voluntary food fortification policy on folate, related B vitamin status, and homocysteine in healthy adults1,2,3

Leane Hoey, Helene McNulty, Nadina Askin, Adrian Dunne, Mary Ward, Kristina Pentieva, JJ Strain, Anne M Molloy, Cliona A Flynn and John M Scott

1 From the Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, United Kingdom (LH, HM, NA, MW, KP, JJS, and CAF); the Department of Statistics, University College, Dublin, Ireland (AD); and the Schools of Clinical Medicine (AMM) and Biochemistry and Immunology (JMS), Trinity College, Dublin, Ireland

Background: Mandatory folic acid fortification of food is effective in reducing neural tube defects and may even reduce stroke-related mortality, but it remains controversial because of concerns about potential adverse effects. Thus, it is virtually nonexistent in Europe, albeit many countries allow food fortification on a voluntary basis.

Objective: The objective of the study was to examine the effect of a voluntary but liberal food fortification policy on dietary intake and biomarker status of folate and other homocysteine-related B vitamins in a healthy population.

Design: The study was a cross-sectional study. From a convenience sample of 662 adults in Northern Ireland, those who provided a fasting blood sample and dietary intake data were examined (n = 441, aged 18–92 y). Intakes of both natural food folate and folic acid from fortified foods were estimated; we used the latter to categorize participants by fortified food intake.

Results: Fortified foods were associated with significantly higher dietary intakes and biomarker status of folate, vitamin B-12, vitamin B-6, and riboflavin than were unfortified foods. There was no difference in natural food folate intake (range: 179–197 µg/d) between the fortified food categories. Red blood cell folate concentrations were 387 nmol/L higher and plasma total homocysteine concentrations were 2 µmol/L lower in the group with the highest fortified food intake (median intake: 208 µg/d folic acid) than in the nonconsumers of fortified foods (0 µg/d folic acid).

Conclusions: These results show that voluntary food fortification is associated with a substantial increase in dietary intake and biomarker status of folate and metabolically related B vitamins with potential beneficial effects on health. However, those who do not consume fortified foods regularly may have insufficient B vitamin status to achieve the known and potential health benefits.

Key Words: Food fortification • folate • folic acid • plasma homocysteine • B vitamins • intakes • biomarkers • dietary folate equivalents • adults






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